Septal Morphology of Lower 2nd Molar with C Canal

In spite of apparently incomplete RCT at #18 with subgingival lingual fracture (Fig.1), there is no bony defect after extraction.  The septum available for osteotomy is between the wide mesiobuccal (MB in Fig.2) and pointed distolingual (DL) sockets.  Initial osteotomy depth is 8 mm over the septum with seemingly 6 mm clearance from the Inferior Alveolar Canal (Fig.3 red dashed line).  When a 5x10 mm implant is placed, it is supracretal lingually (Fig.4 L (B: buccal)).  After implant removal, the osteotomy depth increases by ~ 1mm.  Following untorque for 2nd time to remove MB trapped gauze, the implant loses stability substantially, although the implant is placed deeper (equicrestal lingually; Fig.5 arrow); to keep Vanilla graft/Osteogen (*) in place, a 7.8x4(2) mm abutment is placed with fabrication of an immediate provisional.  PA is taken 3 months postop.  Impression is taken 2 weeks later after placement of a 5.8x4(2) mm abutment with a sleeve.

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Xin Wei, DDS, PhD, MS 1st edition 06/27/2018, last revision 10/11/2018